Altace

Introduction

Written by Kirstyn Hill, PharmD, MPH
Medically reviewed by Alex Brewer, PharmD, MBA
Updated on July 25, 2023

Ramipril (RA mi pril) is a generic medication prescribed for treating high blood pressure in adults, among other uses. Ramipril belongs to a group of drugs called angiotensin converting enzyme (ACE) inhibitors.

The Food and Drug Administration (FDA) has also approved ramipril to:

• lower the risk of heart attack, stroke, or cardiac-related death in certain adults
• treat heart failure in adults who have had a heart attack

Boxed warning: Risk of fetal harm

Ramipril has a boxed warning about the risk of fetal harm. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

For details, see the “Interactions and Warnings for Ramipril” section.

Side effects of ramipril

Ramipril may cause mild or serious side effects. More common mild side effects of ramipril and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about ramipril’s side effects, ask your doctor or pharmacist. You can also refer to the prescribing information for ramipril listed in the “Resources” section.

Mild side effects

More common mild side effects reported with ramipril are listed below.

This article doesn’t include all possible mild side effects of the drug. To learn more about ramipril’s side effects, refer to the prescribing information for ramipril listed in the “Resources” section.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Ramipril oral capsule’s mild side effects include:

• a cough
• headache
• dizziness
• low energy
• mild allergic reaction*

* For details about this side effect, see the “Interactions and warnings for ramipril” section.

Serious side effects

Serious side effects of ramipril are listed below.

This article doesn’t include all possible serious side effects of the drug. To learn more about ramipril’s side effects based on the form, refer to the prescribing information for ramipril listed in the “Resources” section.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, ramipril’s serious side effects include:

• blood cell problems, including neutropenia (low white blood cell count)
• angioedema (severe swelling of the face, lips, tongue, or throat)
• low blood pressure, which can cause dizziness or fainting
• problems with liver function, including liver failure
• high potassium levels, which may lead to an atypical heart rate
• boxed warning: risk of fetal harm*
• severe allergic reaction*

* For details about this side effect, see the “Interactions and warnings for ramipril” section.

Common questions about ramipril

Below you’ll find answers to a few commonly asked questions about ramipril.

Can I take ramipril with coffee?

Yes, you can take ramipril with coffee. Coffee does not interfere with the effectiveness of ramipril, nor does caffeine in general. But your doctor may recommend limiting the amount of caffeine you drink, as it may raise your blood pressure.

If you have high blood pressure and consume products containing caffeine, such as coffee, ask your doctor or pharmacist how much caffeine is safe for you to have.

Is ramipril similar to lisinopril?

Yes, lisinopril (Zestril) and ramipril (Altace) are both angiotensin converting enzyme (ACE) inhibitors. Both drugs can be taken by adults to treat high blood pressure. For this use, lisinopril may also be taken by some children. Both drugs also have other uses that differ.

Because lisinopril and ramipril are both ACE inhibitors, their side effects are similar. Lisinopril comes as an oral tablet. It also comes as an oral solution that’s available only in a brand-name version called Qbrelis. Ramipril comes as an oral capsule.

For more information about how lisinopril and ramipril compare, talk with your doctor or pharmacist.

How does ramipril work? And how long does it take to start working?

Ramipril blocks angiotensin converting enzyme (ACE) in the body. Enzymes are proteins that aid chemical changes in the body.

Usually, ACE produces angiotensin II, another enzyme. Angiotensin II tightens blood vessels, forcing the heart to work harder and blood pressure to increase. With less of this hormone in the body, the blood vessels don’t tighten as much. This makes it easier for your heart to work and helps to decrease blood pressure.

Ramipril starts to lower your blood pressure within an hour of taking the medication. But it may take a few weeks for the medication to take full effect.

If you’d like to know more about how ramipril works, talk with your doctor or pharmacist.

Interactions and warnings for ramipril

Below you’ll find information about ramipril’s possible interactions and warnings.

Interactions of ramipril

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.

Before you take ramipril, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription or over-the-counter drugs
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for ramipril” section below.

Warnings for ramipril

Some people should not take ramipril, and others should take it cautiously.

Boxed warning: Risk of fetal harm

Ramipril has a boxed warning about the risk of fetal harm. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

For details, see the “Pregnancy or breastfeeding and ramipril” section below.

Other warnings

Ramipril could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether ramipril is a safe option for you.

Ask your doctor about specific warnings for ramipril, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Ramipril can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to ramipril or any of its ingredients, your doctor will likely not prescribe ramipril. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to ramipril, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Overdose of ramipril

You should not take more ramipril than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.

If you think you’ve taken too much ramipril, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Pregnancy or breastfeeding and ramipril

Information about ramipril and pregnancy and breastfeeding is described below.

Ramipril and pregnancy

Ramipril should not be taken during pregnancy. If you’re planning a pregnancy or can become pregnant, talk with your doctor before taking this medication. Your doctor may suggest birth control options to use during treatment with ramipril.

Boxed warning: Risk of fetal harm

Ramipril has a boxed warning about the risk of fetal harm. Boxed warnings are the most serious warnings from FDA.

Ramipril and similar drugs may increase the chances of fetal harm and even death if taken during the second and third trimester of pregnancy.

If you become pregnant during ramipril treatment, stop taking the drug and contact your doctor immediately.

To learn more, talk with your doctor or pharmacist.

Ramipril and breastfeeding

Ramipril should not be taken while breastfeeding. If you’re currently breastfeeding or planning to do so, talk with your doctor before using this medication. Your doctor can recommend other ways to feed your child during treatment with ramipril.

Uses of ramipril

The Food and Drug Administration (FDA) approves prescription drugs such as ramipril for certain conditions. Approved uses for ramipril are described below.

Use for lowering blood pressure

Doctors may prescribe ramipril capsules for treating high blood pressure. It’s used for this purpose in adults. It’s usually prescribed as a long-term treatment.

Having high blood pressure increases the risk of heart attack or stroke. By reducing high blood pressure, ramipril helps lower the risk of these conditions.

Ramipril may be prescribed together with other medications that treat high blood pressure. To learn more, talk with your doctor or pharmacist.

Use for lowering risk of certain heart and blood vessel problems

Doctors may prescribe ramipril capsules to help reduce the risk of heart attack, stroke, or cardiac-related death. It’s used for this purpose in adults ages 55 years and older who have a high risk of these conditions. It’s usually prescribed as a long-term treatment.

Ramipril may be prescribed together with other medications that lower the risk of certain heart and blood vessel problems.

Use for treating heart failure in adults who have had heart attacks

Doctors may prescribe ramipril capsules for treating heart failure after a heart attack.

With heart failure, the heart is too weak to pump a sufficient amount of blood throughout the body. As a result, other organs may not receive enough of the oxygen that blood delivers to function properly. Symptoms of heart failure include irregular heartbeat, low energy, and breathlessness.

Ramipril lowers your blood pressure, making it easier for blood to pump through your body. This, in turn, decreases the chances of severe heart failure.

Rampiril may be prescribed together with other medications that treat heart failure.

What to ask your doctor

Let your doctor know if you have questions about ramipril or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• Does ramipril have any long-term side effects?
• Am I at higher risk of side effects than others taking ramipril?
• Should I take ramipril if I experience throat, tongue, or mouth swelling with other medications?

Resources

• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• Lisinopril tablets, for oral use. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/d81deeaf-7e5e-44c5-9348-5923c4e3ccd6/spl-doc
• Ramipril capsules, for oral use. (2022). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/20676a93-af57-40ff-827d-f80892af7517/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.